Prolactin Secreting Tumors Endocrine Status before and after Surgery in 33 Women

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Abstract
Thirty-three women with PRL secreting pituitary adenomas were studied before, during, and after trans-sphenoidal removal of the tumor. Based on neuroradiological evaluation, 2 groups were separated. Group I patients, (18 cases) were characterized by: 1) adenoma confined to the sella turcica; 2) basal plasma PRL concentration of 175 ± 51 ng/ml (mean ± SE); 3) abnormal plasma 24-h PRL profile in contrast to a clear nocturnal rise of GH; 4) variable modifications of plasma PRL under provocative tests; and 5) no pituitary deficiency observed. Group II patients (15 cases) were characterized by: 1) tumor invasion of surrounding structures; 2) basal plasma PRL concentration of 898 ±441 ng/ml; 3) no nocturnal rise of PRL plasma levels, whereas GH levels increased at the onset of sleep in only 3 of 8 patients; and 4) decrease of somatotropic function in 3 cases and gonadotropic deficiency in 3 other cases. Peri-operative estimation of PRL plasma levels showed a fast return to normal levels in group I patients (13 ± 2 ng⁄ml) 2 h after surgery. A 50% decrease of pre-operative PRL levels was obtained in group II patients in the same conditions In all group I patients, an ovulatory cycle was observed 36 ± 5 days after surgery and PRL plasma levels were 9.6 ± 1.2 ng⁄ml 3–12 months after surgery. Nine group I patients became pregnant, among which 5 were followed-up during pregnancy and lactation. No abnormalities were observed during these periods. Among the 9 remaining patients, the 24-h PRL profiles were normal and, in particular, a clear nocturnal rise was observed in patients. PRL response was normal after bromocriptine suppression and TRH stimulation in 7 of the group I patients explored. No pituitary deficiency was noted in any group I patients. In all group II patients, bromocriptine treatment was necessary to reduce PRL plasma concentration to normal levels. The reported data on circumscribed PRL secreting adenomas emphasize the intrapituitary localization of such tumors. Moreover, the elevated plasma PRL levels immediately fell after selective removal of the adenoma. Post-operative follow-up established the absence of any abnormality in the hypothalamo-hypophyseal axis. (J Clin Endocrinol Metab46: 459, 1978)

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